Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis: a functional magnetic resonance imaging study

Fabio Sambataro; Giulia Cattarinussi; Andrew Lawrence; Alessandra Biaggi; Montserrat Fusté; Katie Hazelgrove; Mitul A. Mehta; Susan Pawlby; Susan Conroy; Gertrude Seneviratne; Michael C. Craig; Carmine M. Pariante; Maddalena Miele; Paola Dazzan

doi:10.1038/s41398-021-01351-5

Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis: a functional magnetic resonance imaging study

Fabio Sambataro^*, Giulia Cattarinussi, Andrew Lawrence, Alessandra Biaggi, Montserrat Fusté, Katie Hazelgrove, Mitul A. Mehta, Susan Pawlby, Susan Conroy, Gertrude Seneviratne, Michael C. Craig, Carmine M. Pariante, Maddalena Miele, Paola Dazzan

^*Corresponding author for this work

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Abstract

Postpartum psychosis (PP) is a severe mental disorder that affects women in the first few weeks after delivery. To date there are no biomarkers that distinguish which women at risk (AR) develop a significant psychiatric relapse postpartum. While altered brain connectivity may contribute to the risk for psychoses unrelated to the puerperium, this remains unexplored in PP. We followed up 32 AR and 27 healthy (HC) women from pregnancy to 8-week postpartum. At this point, we classified women as AR-unwell (n = 15) if they had developed a psychiatric relapse meeting DSM-IV diagnostic criteria, or impacting on daily functioning and requiring treatment, or AR-well (n = 17) if they remained asymptomatic. Women also underwent an fMRI scan at rest and during an emotional-processing task, to study within- and between-networks functional connectivity. Women AR, and specifically those in the AR-well group, showed increased resting connectivity within an executive network compared to HC. During the execution of the emotional task, women AR also showed decreased connectivity in the executive network, and altered emotional load-dependent connectivity between executive, salience, and default-mode networks. AR-unwell women particularly showed increased salience network-dependent modulation of the default-mode and executive network relative to AR-well, who showed greater executive network-dependent modulation of the salience network. Our finding that the executive network and its interplay with other brain networks implicated in goal-directed behavior are intrinsically altered suggest that they could be considered neural phenotypes for postpartum psychosis and help advance our understanding of the pathophysiology of this disorder.

Original language	English
Article number	238
Journal	Translational psychiatry
Volume	11
Issue number	1
DOIs	https://doi.org/10.1038/s41398-021-01351-5
Publication status	Published - Jun 2021

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Altered dynamics of the_SAMBATARO_Accepted2March2021_GOLD AAMAccepted author manuscript, 353 KBLicence: CC BY

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Sambataro, F., Cattarinussi, G., Lawrence, A., Biaggi, A., Fusté, M., Hazelgrove, K., Mehta, M. A., Pawlby, S., Conroy, S., Seneviratne, G., Craig, M. C., Pariante, C. M., Miele, M., & Dazzan, P. (2021). Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis: a functional magnetic resonance imaging study. Translational psychiatry, 11(1), Article 238. https://doi.org/10.1038/s41398-021-01351-5

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title = "Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis: a functional magnetic resonance imaging study",

abstract = "Postpartum psychosis (PP) is a severe mental disorder that affects women in the first few weeks after delivery. To date there are no biomarkers that distinguish which women at risk (AR) develop a significant psychiatric relapse postpartum. While altered brain connectivity may contribute to the risk for psychoses unrelated to the puerperium, this remains unexplored in PP. We followed up 32 AR and 27 healthy (HC) women from pregnancy to 8-week postpartum. At this point, we classified women as AR-unwell (n = 15) if they had developed a psychiatric relapse meeting DSM-IV diagnostic criteria, or impacting on daily functioning and requiring treatment, or AR-well (n = 17) if they remained asymptomatic. Women also underwent an fMRI scan at rest and during an emotional-processing task, to study within- and between-networks functional connectivity. Women AR, and specifically those in the AR-well group, showed increased resting connectivity within an executive network compared to HC. During the execution of the emotional task, women AR also showed decreased connectivity in the executive network, and altered emotional load-dependent connectivity between executive, salience, and default-mode networks. AR-unwell women particularly showed increased salience network-dependent modulation of the default-mode and executive network relative to AR-well, who showed greater executive network-dependent modulation of the salience network. Our finding that the executive network and its interplay with other brain networks implicated in goal-directed behavior are intrinsically altered suggest that they could be considered neural phenotypes for postpartum psychosis and help advance our understanding of the pathophysiology of this disorder.",

author = "Fabio Sambataro and Giulia Cattarinussi and Andrew Lawrence and Alessandra Biaggi and Montserrat Fust{\'e} and Katie Hazelgrove and Mehta, {Mitul A.} and Susan Pawlby and Susan Conroy and Gertrude Seneviratne and Craig, {Michael C.} and Pariante, {Carmine M.} and Maddalena Miele and Paola Dazzan",

note = "Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = jun,

doi = "10.1038/s41398-021-01351-5",

language = "English",

volume = "11",

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Sambataro, F, Cattarinussi, G, Lawrence, A, Biaggi, A , Fusté, M , Hazelgrove, K , Mehta, MA , Pawlby, S , Conroy, S, Seneviratne, G, Craig, MC, Pariante, CM, Miele, M & Dazzan, P 2021, 'Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis: a functional magnetic resonance imaging study', Translational psychiatry, vol. 11, no. 1, 238. https://doi.org/10.1038/s41398-021-01351-5

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T1 - Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis

T2 - a functional magnetic resonance imaging study

AU - Sambataro, Fabio

AU - Cattarinussi, Giulia

AU - Lawrence, Andrew

AU - Biaggi, Alessandra

AU - Fusté, Montserrat

AU - Hazelgrove, Katie

AU - Mehta, Mitul A.

AU - Pawlby, Susan

AU - Conroy, Susan

AU - Seneviratne, Gertrude

AU - Craig, Michael C.

AU - Pariante, Carmine M.

AU - Miele, Maddalena

AU - Dazzan, Paola

PY - 2021/6

Y1 - 2021/6

N2 - Postpartum psychosis (PP) is a severe mental disorder that affects women in the first few weeks after delivery. To date there are no biomarkers that distinguish which women at risk (AR) develop a significant psychiatric relapse postpartum. While altered brain connectivity may contribute to the risk for psychoses unrelated to the puerperium, this remains unexplored in PP. We followed up 32 AR and 27 healthy (HC) women from pregnancy to 8-week postpartum. At this point, we classified women as AR-unwell (n = 15) if they had developed a psychiatric relapse meeting DSM-IV diagnostic criteria, or impacting on daily functioning and requiring treatment, or AR-well (n = 17) if they remained asymptomatic. Women also underwent an fMRI scan at rest and during an emotional-processing task, to study within- and between-networks functional connectivity. Women AR, and specifically those in the AR-well group, showed increased resting connectivity within an executive network compared to HC. During the execution of the emotional task, women AR also showed decreased connectivity in the executive network, and altered emotional load-dependent connectivity between executive, salience, and default-mode networks. AR-unwell women particularly showed increased salience network-dependent modulation of the default-mode and executive network relative to AR-well, who showed greater executive network-dependent modulation of the salience network. Our finding that the executive network and its interplay with other brain networks implicated in goal-directed behavior are intrinsically altered suggest that they could be considered neural phenotypes for postpartum psychosis and help advance our understanding of the pathophysiology of this disorder.

AB - Postpartum psychosis (PP) is a severe mental disorder that affects women in the first few weeks after delivery. To date there are no biomarkers that distinguish which women at risk (AR) develop a significant psychiatric relapse postpartum. While altered brain connectivity may contribute to the risk for psychoses unrelated to the puerperium, this remains unexplored in PP. We followed up 32 AR and 27 healthy (HC) women from pregnancy to 8-week postpartum. At this point, we classified women as AR-unwell (n = 15) if they had developed a psychiatric relapse meeting DSM-IV diagnostic criteria, or impacting on daily functioning and requiring treatment, or AR-well (n = 17) if they remained asymptomatic. Women also underwent an fMRI scan at rest and during an emotional-processing task, to study within- and between-networks functional connectivity. Women AR, and specifically those in the AR-well group, showed increased resting connectivity within an executive network compared to HC. During the execution of the emotional task, women AR also showed decreased connectivity in the executive network, and altered emotional load-dependent connectivity between executive, salience, and default-mode networks. AR-unwell women particularly showed increased salience network-dependent modulation of the default-mode and executive network relative to AR-well, who showed greater executive network-dependent modulation of the salience network. Our finding that the executive network and its interplay with other brain networks implicated in goal-directed behavior are intrinsically altered suggest that they could be considered neural phenotypes for postpartum psychosis and help advance our understanding of the pathophysiology of this disorder.

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U2 - 10.1038/s41398-021-01351-5

DO - 10.1038/s41398-021-01351-5

M3 - Article

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AN - SCOPUS:85105771427

SN - 2158-3188

VL - 11

JO - Translational psychiatry

JF - Translational psychiatry

IS - 1

M1 - 238

ER -

Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis: a functional magnetic resonance imaging study

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